On Psychiatry
Some of you have heard my psychiatry rant. In short, it goes like this: Psychiatrists are not doctors, in the "physician" sense. They don't do any of the things I recognize as "being a doctor"; they don't examine patients or their pathologic equivalents (xrays, tissue slides, lab values-doctors do that stuff in some specialities and are still "physicians" in my book). Yes, they went to medical school, they learned all the stuff I learned, and then proceeded to enter a field where most of that knowledge is largely unnecessary.
It's not that mental illness isn't disease-it is, in the truest sense of the word; patients with mental illness are some of the most tormented people I've seen. But the discipline which cares for them is "mental health" (an umbrella term which most people use to include psychologists, social workers, various subsets of counseling and "life coaching", etc.), not "psychiatry". And it's an entirely different mindset.
Recently I picked up a copy of "Unhinged", a critique of psychiatry by Daniel Carlat, a psychiatrist in Newburyport. It's an excellent read, I recommend it highly. But here, in a nutshell, is the issue with "psychiatry", as per Dr. Carlat:
"It is called "medical school" for a reason. Its purpose is to teach students how to combine patient interviews, physical exams, and laboratory tools to diagnose biomedical diseases, and then to combine advice, medications and technical procedures to cure them [ed note: I would add "or control them", but that's a quibble] The basis for it all is an understanding of pathophysiology. But in psychiatry, we do not know the pathophysiology of mental illnesses, and therefore we do not use physical exams or laboratory data to diagnose" [emphasis mine]
He goes on to say trenchant things about why psychiatrists should not go to medical school, arguing persuasively that it's bad for psychiatry and mental health in general (psychiatrists often try very hard to be kings of the mental health hill, because they're doctors, you see), bad for medical school, and bad for patients. He argues for a new model of mental health professional, with a wholly revamped training program, combining the best of the various disciplines which now constitute mental health (psychology, social work, etc.)
I think it's an intriguing idea. And like I said, an excellent book.
(And to hopefully forestall some ranting: yes, there is a neuroscience of mental illness. It isn't ready for prime time. When I can measure your serotonin or norepinephrine, and use that to diagnose your illness or gauge your treatment response, then we'll have another conversation. When I can do a depression scan, or a schizophrenia scan, or a bipolar scan, with some idea of exactly what I'm measuring and use that knowledge to guide treatment, reconsideration may be in order. But psychiatry *isn't there yet*. Mental health has made *immense strides* since Freud invented the idea, and kudos to all the people working in that field both treating patients and working to advance the understanding of their disease. That work needs to keep happening. And medicine and mental health need to work together to care for *our* patients. But psychiatry has become an empty shell of a once proud profession IMO, as understanding of non-mental illness (or perhaps "less mental" illness) has advanced faster than the understanding of mental illness. What that says to me is that mental illness is a hard, complex problem, not that it's less prestigious or not a problem).
It's not that mental illness isn't disease-it is, in the truest sense of the word; patients with mental illness are some of the most tormented people I've seen. But the discipline which cares for them is "mental health" (an umbrella term which most people use to include psychologists, social workers, various subsets of counseling and "life coaching", etc.), not "psychiatry". And it's an entirely different mindset.
Recently I picked up a copy of "Unhinged", a critique of psychiatry by Daniel Carlat, a psychiatrist in Newburyport. It's an excellent read, I recommend it highly. But here, in a nutshell, is the issue with "psychiatry", as per Dr. Carlat:
"It is called "medical school" for a reason. Its purpose is to teach students how to combine patient interviews, physical exams, and laboratory tools to diagnose biomedical diseases, and then to combine advice, medications and technical procedures to cure them [ed note: I would add "or control them", but that's a quibble] The basis for it all is an understanding of pathophysiology. But in psychiatry, we do not know the pathophysiology of mental illnesses, and therefore we do not use physical exams or laboratory data to diagnose" [emphasis mine]
He goes on to say trenchant things about why psychiatrists should not go to medical school, arguing persuasively that it's bad for psychiatry and mental health in general (psychiatrists often try very hard to be kings of the mental health hill, because they're doctors, you see), bad for medical school, and bad for patients. He argues for a new model of mental health professional, with a wholly revamped training program, combining the best of the various disciplines which now constitute mental health (psychology, social work, etc.)
I think it's an intriguing idea. And like I said, an excellent book.
(And to hopefully forestall some ranting: yes, there is a neuroscience of mental illness. It isn't ready for prime time. When I can measure your serotonin or norepinephrine, and use that to diagnose your illness or gauge your treatment response, then we'll have another conversation. When I can do a depression scan, or a schizophrenia scan, or a bipolar scan, with some idea of exactly what I'm measuring and use that knowledge to guide treatment, reconsideration may be in order. But psychiatry *isn't there yet*. Mental health has made *immense strides* since Freud invented the idea, and kudos to all the people working in that field both treating patients and working to advance the understanding of their disease. That work needs to keep happening. And medicine and mental health need to work together to care for *our* patients. But psychiatry has become an empty shell of a once proud profession IMO, as understanding of non-mental illness (or perhaps "less mental" illness) has advanced faster than the understanding of mental illness. What that says to me is that mental illness is a hard, complex problem, not that it's less prestigious or not a problem).